DOI: http://dx.doi.org/10.18203/2349-2902.isj20194417

Comparative study between lymphocyte-monocyte ratio and platelet-lymphocyte ratio: novel markers for critical limb ischemia in peripheral arterial disease

Varsha Swamy, R. Raksha, S. Rajagopalan

Abstract


Background: Peripheral arterial occlusive disease (PAOD) is frequent and often not diagnosed in time. If treatment is not initiated early, disease progression and development of Critical limb ischemia (CLI) is one possible complication. CLI is an entity with high mortality and high risk of limb amputation. As monocytes play a leading role in progression of atherosclerosis and platelets play a key role in atherosclerosis and atherothrombosis, we investigated Lymphocyte-monocyte ratio (LMR), Platelet lymphocyte ratio (PLR) and its association with CLI in peripheral arterial disease.

Methods: Retrospective observational study conducted between January 2015-December 2017 including 50 patients admitted in Rajarajeswari Medical College and Hospital, Bangalore. As an optimal cut-off value, a PLR of 150 and LMR of 5 were identified. Their association with CLI noted.

Results: 50 patients with critical limb ischemia, stage 3 and 4 of Fontaine classification were included in this study. 72% patients had LMR less than 5.40% patients had PLR more than 150 and 36% patients had both LMR less than 5 and PLR more than 150. 96% patients with LMR<5 and 72% patients with PLR>150 underwent amputation.

Conclusions: An increased PLR and reduced LMR are significantly associated with patients at high risk for CLI. They are broadly available and cost effective. When done in early stage of the disease serves as a marker for CLI and aggressive treatment in such patients will reduce the risk of amputation.


Keywords


Critical limb ischemia, Platelet-lymphocyte ratio, Lymphocyte monocyte ratio, Peripheral arterial occlusive disease

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References


Bertomeu V, Morillas P, Gonzalez-Juanatey JR, Quiles J, Guindo J, Soria F, et al. Prevalence and prognostic influence of peripheral arterial disease in patients >or=40 years old admitted into hospital following an acute coronary event. Eur J Vasc Endovac Surg. 2008;36:189-96.

Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45S:S5-67.

Novo S, Coppola G, Milio G. Critical Limb Ischemia: definition and natural history. Curr Drug Targets Cardiovasc Haematol Disord. 2004;4:219-25.

Bertele V, Roncaglioni MC, Pangrazzi J, Terzian E, Tognoni EG. Clinical outcome and its predictors in 1560 patients with critical leg ischaemia. Chronic Critical Leg Ischemia Group. Eur J Vasc Endovasc Surg. 2009;18:401-10.

Management of peripheral arterial disease (PAD). Trans Atlantic Inter-Society Consensus (TASC). J Vasc Surg. 2000;31:S1-296.

Aerden D, Massaad D, von Kemp K, van Tussenbroek F, Debing E, Keymeulen B, et al. The ankle-brachial index and the diabetic foot: a troublesome marriage. Ann Vasc Surg. 2011;25:770-7.

Ross R. Atherosclerosis–an inflammatory disease. N Engl J Med. 2009; 340:115-26.

Carlos TM, Harlan JM. Leukocyte-endothelial adhesion molecules. Blood. 2004;84:2068-101.

Danesh J, Collins R, Appleby P, Peto R. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. J Am Med Assoc. 2008;279:1477-82.

Sabatine MS, Morrow DA, Cannon CP, Murphy SA, Demopoulos LA, DiBattiste PM, et al. Relationship between baseline white blood cell count and degree of coronary artery disease and mortality in patients with acute coronary syndromes: a TACTICS-TIMI 18 (Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis in Myocardial Infarction 18 trial) substudy. J Am Coll Cardiol. 2002;40:1761-8.

Gary T, Pichler M, Belaj K, Hafner F, Gerger A, Froehlich H, et al. Neutrophil-toLymphocyte Ratio and Its Association with Critical Limb Ischemia in PAOD Patients. PLoS One. 2013;8:e5674510.

Tasoglu I, Sert D, Colak N, Uzun A, Songur M, Ecevit A. Neutrophil-lymphocyte ratio and the platelet-lymphocyte ratio predict the limb survival in critical limb ischemia. Clin Appl Thromb Hemost. 2014;20(6):645-50.

Gawaz M, Langer H, May AE. Platelets in inflammation and atherogenesis. J Clin Invest. 2005;115:3378-84.

Lindemann S, Kramer B, Seizer P, Gawaz M. Platelets, inflammation and atherosclerosis. J Thrombosis Haemostasis: JTH. 2007;5(S1):203-11.

Huo Y, Schober A, Forlow SB, Smith DF, Hyman MC, Jung S, et al. Circulating activated platelets exacerbate atherosclerosis in mice deficient in apolipoprotein E. Nat Med. 2003;9:61-7.

Iso Y, Soda T, Sato T, Sato R, Kusuyama T, Omori Y, et al. Impact of implanted bone marrow progenitor cell composition on limb salvage after cell implantation in patients with critical limb ischemia. Atherosclerosis. 2010;209:167-72.

Stabile E, Kinnaird T, la Sala A, Hanson SK, Watkins C, Campia U, et al. CD8+ T lymphocytes regulate the arteriogenic response to ischemia by infiltrating the site of collateral vessel development and recruiting CD4+ mononuclear cells through the expression of interleukin-16. Circulation. 2006;113:118-24.